Acid-Base
What blood sample & tube type is recommended for Blood gas analysis?
Arterial blood & green top tube
What do we expect Cl levels to be in Na is below reference interval? Above reference interval?
If Na is below reference interval then Cl will likely be below RI; If Na is above reference interval then Cl will likely be above RI.
Think "Cl follows Na"
Which of the following should you NOT trust from a dipstick?
A. Leukocytes
B. Nitrate
C. UN
D. Protein
E. pH
F. Blood
G. USG
H. Ketone
I. Bilirubin
J. Glucose
Can pick more than 1.
Leukocytes, Nitrate, UN, USG
Not accurate in Vet med
Explain the difference between Central diabetes insipidus and renal diabetes insipidus.
Central-> ADH is not released by pituitary which means water cannot be reabsorbed leading to very dilute urine.
Renal-> ADH is being released however the cells in the kidney are not responding therefore the kidney is still not reabsorbing water and excreting "pure" h2o
Review the Data Set from a dehydrated dog. What explains the changes in Na+ and Cl-?
Na+ ->Above RI
Cl- -> Above RI
Glucose -> WRI
Osmolality -> Above RI
USG -> 1.002
Hypertonic dehydration
-> likely due to central diabetes insipidus
What is the main difference between Metabolic acidosis vs. Respiratory acidosis?
Metabolic acidosis occurs when there is a decrease HCO3- or tCO2 which tends to lead to a decrease in blood pH
Respiratory acidosis occurs when there is an increase in pCO2
Explain the 3 types of dehydration.
Hypertonic dehydration -> H2O loss > Na+ loss leading to hypernatremia
Isotonic Dehydration -> H2O loss = Na+ loss (normonatremic/isonatremic)
Hypotonic dehydration -> H2O loss < Na+ loss leads to hyponatremia
What are some factors that promote crystal formation in urine?
Concentration of ions in urine, pH (acidic or alkaline), temperature
What causes prerenal azotemia? Renal? Postrenal?
Prerenal -> decrease of renal blood flow (high USG), aka. dehydration or shock
Renal-> decreases functional nephrons (>75% loss), isosthrnuric USG
Postrenal -> obstructive uropathy, urine leakage (uroperitoneum)
A 10 day old calf presents for acute onset of diarrhea (4 days). Calf hasn't eaten in 2 days. Dr. Carl provided electrolytes & SQ fluids. Evaluate data.
Na+: above RI
K+: above RI
Cl-: above RI
HCO3-: below RI
Anion Gap: above RI (high)
What most likely explains these findings?
Administration of oral and fluid rich electrolytes
What changes in HCO3 and PaCO2 represent acidemia vs. alkalemia?
Acidemia: decrease HCO3 or increase of PaCO2
Alkalemia: increase HCO3 or decrease of PaCO2
What are some causes of hypercalcemia?
Primary hyperparathyroidism, HHM, Hypoadrenocorticism
Heme reading on dipstick can mean what? How to determine the cause?
Hematuria: Red blood cells sink don't overthink
Hemoglobinuria: Plasma's red, it's hemoglobin instead
Myoglobinuria: Muscle hurts (CK enzyme increased)
Azotemia is using determined by the market BUN [UN]. What is a better marker in horses?
[Crt]
-Increases in [Crt] and [UN] tend to parallel each other
6-yr-old horse, presented because it passed red urine. Initial CBC didn't show anemia. Chem shows elevated CK enzyme. Based on data what is most likely clinical condition?
Urinalysis
Color - brown
Protein - 2+
Heme - 3+
Sediment: Casts
Myglobin nephrosis
Hypoxemia vs Hypoxia?
Hypoxemia = low oxygen in blood
Hypoxia = low oxygen in tissues
There are three main categories that link to hypokalemia disorders. What are they and what species are they typically linked to?
Increased Cutaneous loss (equine sweat)
Increased Intestinal loss - diarrhea (all species)
Increased Gastric loss - vomiting
*Saliva - cattle (choke)*
Which species is it normal to see trace to 1+ protein in urine?
When can you get a false positive?
Bonus: what other portion of the dipstick is different in dogs?
Dogs *normally don't see any in cats*
Alkaline urine (highly buffered)
Bilirubin - also normal in dogs to have trace to 1+ in conc. urine
For Postrenal azotemia, can we rely on just USG concentration to determine/confirm? Why or Why not?
USG can be any concentration depending on hydration status before obstruction, need clinical signs of difficult urination, frequent urination or anuria for obstructive uropathy
*so that would be a no*
Interpret this data.
pH: Increased/WRI
PaCO2: Increased
HCO3:Increased
Metabolic alkalosis with compensatory respiratory acidosis
Explain why Cl- loss > than Na+ loss in pts w/ metabolic alkalosis.
H+ and Cl- sequestered in stomach/abomasum or loss w/ vomiting
metabolic alkalosis due to gastric epithelium producing HCO3
Disproportional loss of Cl compared to Na
Which of the following can be due to chronic kidney disease in dogs?
A. Hyperkalemia
B. Hypokalemia
C. Hypocalcemia
D. Hypochloridemia
E. Hyponatremia
C. Hypocalcemia
- decreased Vit D due to tubular damage
Most common intoxication in dogs and cats, leads to acute tubular necrosis
Ethylene glycol (antifreeze)
Dog presented for no eating or drinking. PE indicated moderate dehydration. TPR are normal. The dog's abdomen is distended w/ fluid.
[UN] increased
[Crt] increased
[Na+] decreased
[Cl-] decreased
[K+] increased
Based on these results, what is most likely cause of azotemia?
Prerenal & Postrenal due to uroperitoneum
3-yr-old cat, presents with pollakiuria; dehydration. Based on results below, what is likely cause of proteinuria?
No azotemia shown in chem
Urinalysis (Cysto)
Clarity/Color: Cloudy/Pink
Protein: 2+
Heme: Trace
Sediment: many WBCs
An inflammatory proteinuria